Read on for the inside scoop about the people and events behind the scenes at Fauquier Health System - Hospital in Northern Virginia.

Friday, October 20, 2017

Community Gathers to Discuss Fauquier’s Opioid Crisis

FauquierHealth and the Mental Health Association of Fauquier County teamed up on
October 11 for an all-day conference on “Addressing the Opioid Crisis:
Treatment that Works.” The morning’s focus was on the particular vulnerability
of women to opioid addiction – and the downstream effects on their babies, born
addicted. The afternoon introduced best practices for treatment and recovery
and shared the resources that are available in our region.

The major themes
addressed were:

Addiction
is a complex neurobiological disorder, not a moral failing, and is best treated
as a chronic health condition.

Medication
Assisted Treatment (MAT) works and people do recover, though only about 10% of
those addicted to opioids receive MAT.

This
community has come together to address the crisis on multiple fronts, including
the Youth and Family Initiative to create awareness and offer prevention
programs, law enforcement’s reduction of overdose deaths with the use of Narcan,
and expansion of local treatment resources.

Mishka Terplan, MD, MPH, FACOG, FASAM, professor of the departments of Obstetrics and

Dr. Mishka Terplan

Gynecology and
Psychiatry at Virginia Commonwealth University; and Addiction Medicine Consultant for Virginia Medicaid, opened the discussion by making the case for an emphasis on opioid
abuse in women. He explained that between 2004 and 2010, opioid overdose deaths
increased 237 percent for men – an eye-catching statistic. Unfortunately, the
number jumped 400 percent for women. And when women are affected, so are their
babies. Dr. Terplan described the maternal fetal unit by quoting D.W.
Winnicott, saying, “There is no such thing as a baby … If you set out to
describe a baby, you will find you are describing a baby and someone. A baby
cannot exist alone, but is essentially part of a relationship.”

Dr. Terplan said
that pregnant women are motivated to stop using opioids for the sake of their
babies. When they can’t, it is defined as addiction: a brain-centered disease whose
symptoms are behaviors. He explained, “The salient feature of addiction is continued
use in spite of adverse consequences.”

Although pregnant
women are a population most in need of treatment, fewer than 20 percent receive
it, according to Dr. Terplan. Screening is the first step, but most are never
screened for opioid use disorder (OUD). Patients avoid screening because of a fear
of discrimination or judgment; a previous bad experience with health care
provider; a fear of Child Protective Services; or they don’t consider their use
problematic. Some physicians can be resistant too, citing a lack of time or
payment and lack of knowledge about what to do if a patient screens positive.

Addressing the
audience next was Alta DeRoo, MD, FACOG, FASAM, associate professor, OB/GYN, at
the University of Virginia. She is the director of OB/GYN at UVA Health System,
at Culpeper Medical Center, and is an addiction medicine consultant. She spoke
on the screening and treatment of opioid use disorders in pregnancy.

Dr. DeRoo began by
quoting another sobering statistic: “The Virginia Department of Health reports
16 percent of pregnant members had substance use disorder.” She then gave
specifics on treatment options, including the effectiveness of administering
buprenorphine or methadone in combination with counseling to help pregnant
women cope with opioid addiction.

addressed the need for a
community effort to improve the outcome of neonatal abstinence syndrome (NAS).
Dr. Mainali brought the opioid crisis down to the local level by sharing that
11 people died in 2016 from opioid overdoses, four in the town of Warrenton. In
2016, 741 Virginia babies were hospitalized for NAS.

She drew a picture
of what NAS babies endure after then are born. When an addicted baby is
admitted to Fauquier’s NICU, the hospital’s neonatal team works to reduce the
amount of stimuli the baby experiences. A baby born addicted must be:

Placed in a quiet room with dim lighting and low
activity.

Moved away from telephone or high traffic areas

Handled with slow movements and caregivers should avoid
talking at the bedside

Disturbed as little as possible

Experience one stimulus at a time (rocking, voice, soft
music, etc.)

In
addition, caregivers can provide the following supportive therapies:

•Wrap or swaddle infant; use short-haired sheepskin with
a soft cotton sheet

•Hold the infant firmly and close to the body

•Promote skin to skin contact and use of infant sling

•Massage infant or try relaxation baths

•Rock gently, talk, sing or hum softly

•Play heartbeat audiotapes

•Decrease stimulation at first signs of distress

•Feed on demand – give frequent small feeds with rests
between sucking

Dr. Mainali joined
the panel discussion that followed, which also included Dr. Terplan, Dr. DeRoo
and Fauquier Health Emergency Department chairman Michael Jenks, MD. Panelists
answered questions from the audience, which focused on MAT and related issues.

Consultant for the National Council for Behavioral Health, offered advice to
addiction counselors. He explained the best ways to gain the trust and
cooperation of clients and spoke of stigma and discrimination as barriers to
change. He quoted Dr. Michael Miller, ASAM: “At its core, addiction isn’t just
a social problem or a moral problem or a criminal problem. It’s a brain problemwhose behaviors
manifest in all these other areas…Many
behaviors driven by addiction are real problems and sometimes criminal acts.
But the disease is about brains, not drugs. It’s about underlying neurology,
not outward actions.”

Szubiak detailed
how addiction develops, and also emphasized the important role of primary care
physicians in screening, brief interventions and referral for treatment of
substance use issues.

Ashley Clark, PhD,
QMHP, program manager of Outpatient Mental Health and Substance Use

Services for Rappahannock Rapidan Community Services, was
the final guest speaker. She ended the conference on a hopeful note by
enumerating all of the services available in the area, from residential options
to local supplemental services like:

•Infant Toddler Connection

•Fauquier Link

•Crisis Services

•Child Mobile Crisis

•Parent Café

New services coming
online through Rappahannock Rapidan Community Services include

Ashley Clark, PhD

expansion of
MAT, new intensive outpatient groups, and a treatment program to address
substance use issues in young adults.

Sallie Morgan

Sallie Morgan, of
the Mental Health Association of Fauquier, was enthusiastic about the forum. “We’ve
heard a lot about the scope of the opioid crisis and its impact on this region,
and now it is time to focus on solutions. The Surgeon General has defined the
need to address opioid addiction and other substance use issues as a moral test
of each community, and Fauquier is really rising to meet that test. Medical
professionals and community members coming together to learn more about
effective treatment is part of a larger, community–wide effort to offer
prevention programs, treatment options, and support for individuals in recovery.”